One of the commonest diagnostic tests done for managing the infertile make is called a testis biopsy . Even though it’s a simple, inexpensive, minor procedure, it’s surprising how often it is misused today.
I would like to share some information about this, so you don’t allow doctors to take you for a ride.
Part of the problem is that IVF specialists are usually gynecologists , which means they don’t understand much about examining or treating an infertile man . Many will often end up referring these men either to a urologist or an andrologist , and the problem is that the left hand has absolutely no idea what the right hand is doing , as a result of which these infertile men often end up falling in between 2 stools , and end up getting inappropriate treatment .
One common problem is the overuse of testis biopsy , and a lot of men with severe oligospermia end up being subjected to an unnecessary testis biopsy . The reason this is unnecessary because a testis biopsy should strictly only be done for men with azoospermia , because the only role a testis biopsy has is to help to identify what the reason for azoospermia is . It’s obvious that if any sperms are present in the semen ( even an occasional sperm !) , then they are being produced in the testis , which means if you do a testis biopsy for these men , you are 100% sure that you are going to find sperm production in the biopsy, as a result of which doing a biopsy for these men is completely pointless . However, doctors will continue doing the testicular biopsy , and will continue misinterpreting it !
Adding even further insult to injury is that many of them do a testis biopsy as a therapeutic procedure for infertile men, as part of the TESE-ICSI treatment cycle ! If the sperm count is poor or if the sperm DNA fragmentation is high , they justify this by saying that if they extract the sperm directly from the testis , the DNA damage to the testicular sperm will be less, as a result of which the fertilization rate will be better and the chances of getting pregnant will improve. This is a complete lie , and it is just a way of taking these poor patients for a ride !
Not only is a testis biopsy overused , most doctors don’t even bother to do them properly ! Many doctors don’t even bother to do a proper biopsy, and instead do a much simpler procedure called a FNAC, or a fine needle aspiration cytology. It’s much easier for the doctor to do this, because he just needs to stick a needle in the testis and suck , but the problem with an FNAC is that the diagnostic information it provides is extremely limited – and is often wrong – especially for men with partial testicular failure , where it’s common to have false negatives. This means that the FNAC result will come back as negative , but if they had done a proper testicular biopsy , they would find that sperms are being produced in a few patchy areas in the testis !
Finally, because a testis biopsy is such a simple procedure , many doctors will not bother do it properly. They take a shortcut by sampling only one area from one testis, instead of sampling many areas from both testes, which is the right way of doing a proper testis biopsy. What’s even worse is that instead of sending it in a special preservative called Bouin’s fluid to a specialised pathologist who is an expert at interpreting these biopsy samples , they will end up sending it in formalin , which is the standard preservative solution which is used for surgical biopsy. However, this formalin damages the testicular tissue so much that no pathologist will be able to interpret that slide properly at all , as a result of which a lot of these patients get completely confused , because they are not getting the right information they need.
What does this mean for you as a patient ? If your doctor says you need a testis biopsy , please do your homework , and this is one of the reasons why we have written this particular article . Please don’t let him do a biopsy if there are any sperm at all in the semen , because the biopsy will not provide you with any useful information . And if you do need a biopsy , make sure that the doctor does multiple micro biopsies , and sends the sample in Bouin’s fluid . And if the doctor doesn’t have this, this clearly means that you are in the wrong clinic , and you need to find a better doctor ! Please guard your family jewels with care , and don’t allow doctors to misuse them !
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